An Unnecessary Predicament

Who else remembers being sick as a kid?


Maybe you were from a “rough n’ tough” type of family who made you do chores even when you were ill. I came from a home where being sick was code for being king for a day.


My mom would attend to me at the drop of a hat. My feverish brow was stroked and my favorite snacks were delivered to me in bed. The cartoons were unlimited and the naps were long.


It would be a living nightmare as a kid to feel crummy and then have my mom come in and say, “Okay buddy. Enough with your griping and moping. Time to get up and go to school.”


Sadly, many folks in retirement are faced with almost this exact predicament. They’re in the hospital and still recovering when they are forced to leave early due to Medicare coverage running out.


If you end up in the hospital and find out that you are being released earlier than you (or your doctors) would like, what can you do?


1. Make an Expedited Appeal
When you were admitted to the hospital, you should have received a notice called “Important Message from Medicare.” On this notice are instructions for filing a fast appeal. Your appeal will be sent to the Quality Improvement Organization. The QIO should call you within 24 hours with their decision. Make sure you file this appeal no later than midnight on the day of your scheduled discharge.


2. Keep Appealing
Your request to stay denied by the QIO? You have the right to continue to appeal to higher levels of review. If you stay in the hospital after the QIO decision though, you may be responsible for paying for your stay out of pocket if you don’t win at a higher level of appeal.


3. Be Proactive – Start with Better Coverage

So many hospital headaches could be avoided if people started with good coverage in the first place. For example, my grandmother had to stay at the hospital for over 100 days, and paid $0 out of pocket! She had amazing coverage. You can too!

I would hate for anyone to have to leave a care setting before they are ready, simply due to lack of coverage. This is why I do what I do: I love giving folks peace of mind in their vulnerable moments.

Posted in Medicare.

Leave a Reply

Your email address will not be published. Required fields are marked *